Provider Demographics
NPI:1396202511
Name:UMBRELLA HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:UMBRELLA HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FIDELIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SAB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-350-9677
Mailing Address - Street 1:1036 LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-2915
Mailing Address - Country:US
Mailing Address - Phone:202-601-5310
Mailing Address - Fax:
Practice Address - Street 1:2301 GEORGIA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-3000
Practice Address - Country:US
Practice Address - Phone:202-601-5310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-24
Last Update Date:2019-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities